The Senior Provider Network Operations Analyst serves as a subject matter expert within Provider ... configuration, provider data, and related network operations. Work Arrangement: * Remote - This ...
The Senior Provider Network Operations Analyst serves as a subject matter expert within Provider ... configuration, provider data, and related network operations. Work Arrangement: * Remote - This ...
Compliance Product Analyst I
East Lansing, MI · On-site +1
$50K - $55K/yr
... configuration A successful analyst will learn the product and how to maintain it. The analyst will ... Ability to work remote with a stable internet connection on an as needed basis * Occasional lifting ...
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Compliance Product Analyst I
East Lansing, MI · On-site +1
$50K - $55K/yr
... configuration A successful analyst will learn the product and how to maintain it. The analyst will ... Ability to work remote with a stable internet connection on an as needed basis * Occasional lifting ...
SAP Functional Business Analyst (PS/PM/RE-FX)
Battle Creek, MI · Remote
$121K - $151K/yr
While our company operates as a remote-first organization, this position requires onsite work in ... leads functional configuration and impact assessment efforts across SAP Real Estate Management ...
SAP Functional Business Analyst (PS/PM/RE-FX)
Battle Creek, MI · Remote
$121K - $151K/yr
While our company operates as a remote-first organization, this position requires onsite work in ... leads functional configuration and impact assessment efforts across SAP Real Estate Management ...
Senior Workday Security Analyst
Novi, MI · Remote
$90K - $117K/yr
Security Configuration & Administration Lead the configuration and administration of Workday ... Strong analytical and documentation skills #LI-Remote Why Lineage? This is an excellent position to ...
Senior Workday Security Analyst
Novi, MI · Remote
$90K - $117K/yr
Security Configuration & Administration Lead the configuration and administration of Workday ... Strong analytical and documentation skills #LI-Remote Why Lineage? This is an excellent position to ...
Analyst - Marketing Engineering
Flint, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Flint, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Mount Pleasant, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Mount Pleasant, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Rochester Hills, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Rochester Hills, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Kalamazoo, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Kalamazoo, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Lansing, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Lansing, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Allendale, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Allendale, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Ann Arbor, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Ann Arbor, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Sterling Heights, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Sterling Heights, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Warren, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Warren, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Grand Rapids, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Grand Rapids, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Berrien Springs, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Berrien Springs, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Detroit, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Analyst - Marketing Engineering
Detroit, MI · On-site +1
$34.23 - $51.35/hr
... reading configuration or code well enough to understand what a workflow is doing. * Excellent ... Strong remote candidates will be considered, with less than 10% travel to St. Louis. Who You Are ...
Workday Absence & HCM Senior Analyst
Grand Rapids, MI · Remote
$86K - $110K/yr
Manage Skills Cloud governance and related configuration * Address roadblocks to deliver ... LI-SAW #LI-Remote POSITION REQUIREMENTS: Education Bachelor's degree in Human Resources ...
Workday Absence & HCM Senior Analyst
Grand Rapids, MI · Remote
$86K - $110K/yr
Manage Skills Cloud governance and related configuration * Address roadblocks to deliver ... LI-SAW #LI-Remote POSITION REQUIREMENTS: Education Bachelor's degree in Human Resources ...
Systems Analyst - Rebus
Ann Arbor, MI · On-site +1
This role is Remote in the United States. Once you join our team, you will... * Design and ... configuration end to end * Build data extractions through data mining and analysis; write, optimize ...
Systems Analyst - Rebus
Ann Arbor, MI · On-site +1
This role is Remote in the United States. Once you join our team, you will... * Design and ... configuration end to end * Build data extractions through data mining and analysis; write, optimize ...
Litigation Project Analyst
Detroit, MI · On-site +1
The Litigation Project Analyst position is fully remote and open to our offices in California ... Working knowledge of RelativityOne, including basic workspace configuration and review workflows.
Litigation Project Analyst
Detroit, MI · On-site +1
The Litigation Project Analyst position is fully remote and open to our offices in California ... Working knowledge of RelativityOne, including basic workspace configuration and review workflows.
Litigation Project Analyst
Lansing, MI · On-site +1
The Litigation Project Analyst position is fully remote and open to our offices in California ... Working knowledge of RelativityOne, including basic workspace configuration and review workflows.
Litigation Project Analyst
Lansing, MI · On-site +1
The Litigation Project Analyst position is fully remote and open to our offices in California ... Working knowledge of RelativityOne, including basic workspace configuration and review workflows.
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Senior Provider Network Operations Analyst
Southfield, MI • Remote
Full-time
Posted 12 days ago
AmeriHealth Caritas rating
8.3
Based on 73 frontline employees who took The Breakroom Quiz
Job description
Role Overview: The Senior Provider Network Operations Analyst serves as a subject matter expert within Provider Network Operations and is responsible for operational accuracy, regulatory compliance, claims configuration, provider data, and related network operations.
Work Arrangement:
- Remote - This position is fully remote; the associate must be located in Michigan (MI) and attend monthly meetings as needed in Southfield, MI.
- Requires reliable high-speed internet (minimum 50 Mbps download / 5 Mbps upload)
- Internet reimbursement may be available where required by law or contract
Responsibilities:
- Review/approve and audit Payment Integrity (PI) vendor and internal prospective and retrospective edits/projects/recoveries.
- User Acceptance Testing (UAT)/Client Review & audit (provider data, Appian Advanced Group ID (AGID) configuration, and set-up concentration) reviews requests prior to initial submission to Enterprise Operations (EO) and claims post-production.
- Facets claims edit configuration concentration (Appian) – intake, review, impact assessment, and initial submission; UAT reviews requests prior to initial submission to EO and claims post-production.
- Encounter error reconciliation representation, oversight, and management – including identification and initiation of claim or provider changes necessary to mitigate/prevent future errors.
- Management and resolution of state complaints.
- State policy and contract amendment changes analysis and management.
- Internal or vendor medical policy or Health Value Optimization (HVO) edit changes and initiatives.
- Monitor and review state communications and changes, lead initial analysis/determination of action, provide direction on work request submissions to level I analysts, and test/audit subsequent changes.
- Business Process Outsourcing (BPO) and/or other intake/workflow tool management.
- Single-case agreement management/ownership, including letter development and coordination with Provider Network Management (PNM).
- Serves as the subject matter expert in state-specific health reimbursement rules and provider billing requirements and as liaison to the Enterprise Operations Configuration Department.
- Maintain a current working knowledge of processing rules, contractual guidelines, state/Plan policy, and operational procedures to effectively provide technical expertise and business rules.
- Acts as the resource to other departments by developing and managing work plans which document the status of key relationship issues and action items for high-profile providers.
- Performs other related duties and projects as assigned
Education & Experience:
- American Academy of Professional Coders (AAPC) certification (CPC, COC, CIC, CRC) or NHA (CBCS) certification required.
- Associate’s degree preferred, or equivalent combination of education and experience in a healthcare field.
- 3 to 5 years of claims analysis experience in healthcare, managed care, or Medicaid environment preferred.
- Claims processing and Provider data maintenance knowledge required
- Understanding of and experience related to healthcare claims payment configuration process/systems and its relevance/impact on network operations required
- Strong working knowledge of Microsoft Excel, Access, Word, and other MS Office tools; ability to work with pivot charts, Access databases, and data analytics.
Skills & Abilities:
- Ability to focus on technology and business issues, as well as communicate appropriately with both technology and business experts
- Strong analytic problem-solving skills
- Superior organizational skills required
- Critical thinking skills
- Strong customer service skills
- Data and reporting analysis
What AmeriHealth Caritas employees say
Pay
Benefits
Hours and flexibility
Workplace
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About AmeriHealth Caritas
Sourced by ZipRecruiter
Industry
Health care and social assistance
Company size
5,001 - 10,000 Employees
Headquarters location
Philadelphia, PA, US
Year founded
1983